Advocate

[ChrisPAinED]

I saw a unusual case a long time ago while I was a first year at my hospital. This Case had some great learning opportunities. Ok so here we go.

So a middle aged woman came in with heart palpations. I looked at chart before going to see her and I saw that she had a irregular pulse, but a normal heart rate that did occasionally go up into low 100s otherwise good vitals. I saw that she was previously healthy but doesn't see a primary care provider. Her ECG that was already done showed irregular sinus rhythm. Now I was done looking at the chart and ready to see the patient for myself. I was in there confirming a history doing a exam for about 10minutes and noticed she had a few PVCs in that short time. So what did I do? I ordered some of the basics. CBC, BMP, and a troponin. Also had a IV placed Incase we needed more labs or needed to give meds or fluids. So CBC and BMP we're normal which I kinda expected. Troponin was elevated at 3.50 instead of 0.04 or less. So I was a bit confused about what was going on so I asked the ER doc that was signing off on my cases. I remember him being really dismissive. I remember him saying the troponin is probably from the moments of tachycardia, the palps are from the irregular rhythm which is probably fine, so he said I could get a referral to cardiology for eval of the irregular rhythm and PVCs. In our ED we always try to get a appointment set up for our patients before discharge so I was getting that set up and that appointment was originally set for in 6weeks and patient was unhappy and concerned by that. I too was concerned and I remembered that when I was shadowing a social worker when I was a pre pa that we have to advocate for our patients if we or they don't feel safe. So I talked with the cardiology provider and got to negotiate a appointment for in 2 days which I felt more comfortable with. Patient also was pleased with that. I really didn't know what was going on but I knew it wasn't a emergency because troponin was checked again before discharge which was the same not more and vitals were normal. So lesson is to advocate for your patients if you or they don't feel comfortable with the plan. This patient later came a few months later and thanked me personally for taking her seriously. She had a ablation done and was doing much better. This was so rewarding to see how much better she was doing. One of the best parts of being a PA is getting to see the change you can make.